Online registration

Please fill out ALL fields of this form. If you have any questions or concerns you’d like to discuss with us, please call us on 818-758-3832.

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

Student Profile
 
First
Last
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Is the natural mother of the child Jewish? Yes No
Have there been any conversions or adoptions in the family? If Yes, please explain.

Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Address
City
State
Zip
Email Address
Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
General info
 
Does your child have any difficulties with general studies? Yes No
To enhance our curriculum we have school events and programs. Would you be willing to assist in event planning? Yes No
Would you like to be a class mother? Yes No
Would you or your teenage child volunteer to help a Special Needs child in our community with the Friendship Circle program? Yes No

I would you like to make a donation to the Hebrew School Scholarship fund

Please email me more information regarding Chabad activities

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

Payment Information

 

I would like to pay a one-time installment of $800
Payment amount $
Name on card First  Last 
Credit Card Number
Billing Address
Expiration Date
CVV

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

If for any reason you decide to cancel during the year, you will be refunded from the beginning of the next month.

There are no refunds after April 1st.

 

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!